•Experts analyse 6 deaths in Lagos, 76 in
Ebonyi. Cholera outbreak in some parts of the
country leaves much to be desired. Since
the outbreak, health watchers have been
wondering why the country, at 56, is still
faced with such occurrence. To some, it
brings to the fore the state of the
environment, the endemic poverty in the
land and the lack of basic amenities when it
should have outgrown such primary health
challenges.
The bottomline is that millions of people
residing in slums across the nation have no
access to potable water, no toilet facilities,
open sewage is common place while open
defecation is the order of the day.
This condition exposes hapless Nigerians to
infections such as cholera.
Cholera infection
Cholera, according to the World Health
Organisation’s (WHO) definition, is an acute
diarrhoeal infection caused by ingestion of
food or water contaminated with the
bacterium vibrio cholerae O1 or O139.
It is a global threat to public health and a
key indicator of lack of social development.
To WHO, the re-emergence of cholera has
been noted in parallel with the ever-
increasing size of vulnerable populations
living in unsanitary conditions.
According to a study on “Cholera
Epidemiology in Nigeria: an overview”,
carried out by Ajoke Olutola Adagbada and
colleagues, cholera made its first
appearance in 1972. Unfortunately, the latter
part of 2010 was marked with severe
outbreak which started from the northern
part of Nigeria, spreading to the other parts
and involving approximately 3,000 cases and
781 deaths.
The study also showed that the 2010
outbreak of cholera and gastroenteritis and
the attendant deaths in some regions in
Nigeria brought to the forefront the
vulnerability of poor communities and most
especially children to the infection.
The outbreak was attributed to rain which
washed sewage into open wells and ponds,
where people obtain water for drinking and
household needs. The regions ravaged then
were Jigawa, Bauchi, Gombe, Yobe, Borno,
Adamawa, Taraba, FCT, Cross River,
Kaduna, Osun and Rivers.
The study also noted that even though the
epidemic was recorded in these areas,
epidemiological evidence indicated that the
entire country was at risk.
Unfortunately, years later, the disease
outbreak has continued to kill.
From 2015 to date, many states in Nigeria
have been hit by the infection. The states
include Lagos, Ogun, Oyo, Plateau and
Zamfara. Critical observers are worried that
the frequency of occurrence is indicative of
a huge shortfall in human development index
and a failure of leadership in the country’s
health sector. Statistics from UNICEF
showed that over 500 Nigerians lost their
lives in the 2015 outbreak.
The worst hit this year is Ebonyi where
cholera killed 76 persons in April, while six
died in Lagos and 66 were affected.
According to the state Commissioner for
Health, Dr. Daniel Umuzuruike, apart from
the 76 deaths from cholera, 14 other
patients died of Lassa fever. The cholera
outbreak also affected 38 communities and
11 out of the 13 LGAs of Ebonyi.
Why cholera will persist
So why is Nigeria finding it difficult to stop
cholera? According to health experts, the
reasons are not far-fetched. The experts
believe that far as long as people urinate
and defecate in the open while wastes are
washed into open filthy drains, cholera will
continue to be with us. Meanwhile, the
chances of contamination are very high
from roadside food vendors and people
eating in unhygienic condition. People eat
from various sources.
According to Lagos State Commissioner for
Health, Dr Jide Idris, it is a shame that the
country is experiencing cholera in the 21st
century because people are yet to
understand personal hygiene.
Idris disclosed that the main suspected
source of infection in the latest outbreak of
cholera in the state was a local salad
popularly called Abacha and some domestic
wells
He maintained that prevention of cholera
can be achieved through basic water
sanitation, such as boiling water of unclean
sources, adding: “Cholera can kill within
hours if left untreated.”
Giving measures to prevent the spread of
the disease, he said: “Wash your hands with
soap and water frequently and thoroughly
especially after using the rest room to
prevent cholera. “There should be no open
defecation,” he added.
Indeed, a UNICEF report showed that over
50 million Nigerians defecate in the open.
Unfortunately, experts say ingesting a
gramme of faeces deposited by houseflies
on uncovered food is like eating 10 million
viruses, one million bacteria, 1,000 parasite
cysts and 100 parasite eggs.
And this does not only cause cholera but
also typhoid, hepatitis, polio, pneumonia,
fatal worm infestation, trachoma, stunted
physical development and impaired cognitive
functions.
Statistics also indicate that diarrhoea kills at
least 150,000 children yearly, while under-
five mortality is high in Nigeria where 157
out of 1,000 babies born die before they
celebrate their fifth birthday.
Diarrhoea discharge
Usually, the source of the contamination is
other cholera patients when their untreated
diarrhoea discharge is allowed to get into
water supplies. Sunday Vanguard gathered
that cholera is not likely to spread directly
from one person to another; therefore,
casual contact with an infected person is
not a risk for becoming ill but this does not
excuse non-observance of good sanitation.
Simple things like washing your hands
before eating and nursing the baby, washing
your hands after relieving yourself, purifying
the water before drinking and stopping open
defecation and ensuring better sewage
systems saves lives and stop the spread of
cholera.
Cholera usually presents clinically as
nausea, profuse diarrhoea, vomiting (in early
stages of illness), fever and leg cramp.
Later presentation is dehydration, shock or
coma. Health watchers are of the view that
since the factors fuelling cholera in Nigeria
have been linked to dirty environment,
poverty, lack of good water sources, there is
need to bring back sanitation officers.
Symptoms
About 75 percent of people infected with
cholera do not develop any symptoms,
although the bacteria are present in their
faeces for 7–14 days after infection and are
shed back into the environment, potentially
infecting other people.
Among people who develop symptoms, 80
percent have mild or moderate symptoms,
while around 20 percent develop acute
watery diarrhoea with severe dehydration.
This can lead to death if untreated. The
case fatality of cholera ranges from less
than 1 percent in treated cases to as high
as 50 percent in severe cases.
Prevention tips
Boil water before drinking, especially if you
are not sure of the source of infection
• Keep all cooking utensils, plates, cutleries,
cups and other materials clean before and
after use, cover foods and water sources,
cook foods adequately.
•Store foods in fridges, wash fruits and
vegetables thoroughly
•Dispose of waste materials appropriately;
there should be no open defecation
•There should be no body contact, especially
hand contact with faeces.
•Regular food handlers’ test
•Provision of effective and hygienic toilet
facility
Where cholera is suspected:
• Prepare oral rehydration solution (10 level
teaspoonful of sugar + 1 level teaspoon of
salt in two 35cl bottles).
•Keep giving food as soon as it can be
tolerated
•Report any case of diarrhoea and vomiting
to the nearest public or private health
facilities.
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